针灸改善慢性疼痛的新视角:“针灸治神”调控负性情绪及奖赏/动机环路

Chronic pain is often accompanied by negative emotions,and the progression of negative emotions may further impede pain relief.Both chronic pain and negative emotions are closely associated with reward/motivation circuits.Treatment with acupuncture is effective for the relief of pain and emotional disorders,although the acupoint combinations vary.Thus,this study aimed to elucidate the relationship of chronic pain and emotional disorders with the reward/motivation circuits.In association with the theory on "seven emotional factors that cause pain" in traditional Chinese medicine,the potential effect mechanism of "spirit-regulation with acupuncture" for the relief of chronic pain and negative emotions was explored.The findings suggest that chronic pain and its related negative emotions may be effectively relieved with acupuncture after optimizing its acupoint combination based on "spirit-regulation".However,the role of reward/motivation circuits for negative emotions in the relief of chronic pain with acupuncture needs to be demonstrated.

The Periaqueductal Gray and Its Extended Participation in Drug Addiction Phenomena

The periaqueductal gray(PAG)is a complex mesencephalic structure involved in the integration and execution of active and passive self-protective behaviors against imminent threats,such as immobility or flight from a predator.PAG activity is also associated with the integration of responses against physical discomfort(e.g.,anxiety,fear,pain,and disgust)which occurs prior an imminent attack,but also during withdrawal from drugs such as morphine and cocaine.The PAG sends and receives projections to and from other well-documented nuclei linked to the phenomenon of drug addiction including:(i)the ventral tegmental area;(ii)extended amygdala;(iii)medial prefrontal cortex;(iv)pontine nucleus;(v)bed nucleus of the stria terminalis;and(vi)hypothalamus.Preclinical models have suggested that the PAG contributes to the modulation of anxiety,fear,and nociception(all of which may produce physical discomfort)linked with chronic exposure to drugs of abuse.Withdrawal produced by the major pharmacological classes of drugs of abuse is mediated through actions that include participation of the PAG.In support of this,there is evidence of functional,pharmacological,molecular.And/or genetic alterations in the PAG during the impulsive/compulsive intake or withdrawal from a drug.Due to its small size,it is difficult to assess the anatomical participation of the PAG when using classical neuroimaging techniques,so its phys-iopathology in drug addiction has been underestimated and poorly documented.In this theoretical review,we discuss the involvement of the PAG in drug addiction mainly via its role as an integrator of responses to the physical discomfort associated with drug withdrawal.